Category: Opinions

My daughter has a smartphone cover that says: “We’re all mad here”. It’s from Alice in Wonderland. I like it; and when it comes to hepatitis C treatment and pricing, it’s quite on point.

In 2014, Canada and the rest of the world turned a miraculous corner – a cure for viral hepatitis C was on the market. Wonderful and amazing. Why? Well, viral hepatitis C is the only chronic viral infection that now has a cure – that is, a cure for virtually everyone, with a cure rate of 95 per cent.

One of the most memorable moments in my 20 years working in the HIV field happened in a standing-room-only meeting hall in Vienna at the International AIDS Conference in 2010. This was the moment that the clinical trial CAPRISA 004 announced proof-of-concept for prevention of HIV among women using a vaginal microbicide (1% tenofivir gel). The entire room broke out in a standing ovation and tears of joy. Finally! A prevention tool that could allow a woman to protect herself in sexual encounters, regardless of the desires and wishes of her sexual partner. Five years later, microbicides have not yet come to fruition. But pre-exposure prophylaxis (PrEP) holds the same great promise.

Hepatitis C is curable, reads the script; time and time again I hear this said, have read it, and say it myself. This is great news and a reality for more people than ever before.

Does this mean that the job is done? I suppose it depends on one’s perspective. As I listened to members of the science research community speak recently, it is “done and dusted.” “Problem solved,” the headlines will read. Okay, maybe no headlines but a mention on page 4 with a minor piece in the late evening news, even though this may be the biggest news in medical science in decades.

There is a quiet tension that exists surrounding HIV and infant feeding. Although practices and recommendations vary around the world, breastfeeding is not recommended for infants born to an HIV-positive woman or trans man in Canada. Instead, HIV-positive parents are counselled to feed their infants with formula.

But I don’t think it is by any means a closed case, even in Canada. The truth is, the debate about HIV and infant feeding (particularly in Canada) has never been more complex. Like so many discussions related to HIV today, scientific advances are changing the way we talk about and consider possibilities. New questions about treatment as prevention, pre-exposure prophylaxis (PrEP), and even levels of ‘risk’ seem to emerge every day.

A test is a test, right? I’ve struggled with the issues of why HIV testing matters over the last 25 years, and over that time I’ve seen the ebb and flow of debates and discussions on why testing is still an important issue for Canada. I’ve also seen the frustration among those who do not have access to testing and why that matters. Yes, knowing your HIV status is still an important health issue for Canadians. However, with the complex array of debates on the pros and cons of testing, including the very real concerns about confidentiality; the need for pre- and post-test counselling; limited access to testing innovations such as point-of-care testing (POCT); the gendered nature of testing along with some popular misconceptions about it, there is definitely room for improvement moving forward. Simply put: We can and must do better in our national leadership around HIV testing issues in this country.